The ‘Ebola Ambassadors’ Talk About Death, Determination

By Larry Luxner Uploaded on November 26, 2014

Ambassador Bockari Kortu Stevensof Sierra Leone won’t soon forget the steamy hot August day he accompanied the president of his West African country, Ernest Bai Koroma, to an Ebola emergency treatment center in Freetown, the capital.

“It was a somber moment for us. This was the first time he had seen the disease for himself,” Stevens said, recalling the emotionally devastating visit. “These people in front of him knew they were going to die, and there was nothing he could do about it.”

Photo: Lawrence Ruggeri of ruggeriphoto.com

From left, Ambassador of Sierra Leone Bockari Kortu Stevens, Ambassador of Guinea Mamady Condé and Ambassador of Liberia Jeremiah Congbeh Sulunteh talk to The Diplomat about the Ebola crisis in West Africa.

It was then and there Koroma decided he wouldn’t be able to join 50 other heads of state already departing for Washington to attend the 2014 U.S.-Africa Leaders Summit. Instead, the president immediately declared Sierra Leone to be in a state of emergency and announced stringent new security measures to contain the growing epidemic.

In neighboring Liberia, President Ellen Johnson Sirleaf also skipped the summit, sending her vice president instead. She shut down the country’s schools, placed all nonessential government workers on 30-day leave and closed Liberia’s borders with all neighboring countries.

Guinea, an impoverished French-speaking nation of 12 million, is larger than Sierra Leone and Liberia combined. It’s also where the current West African outbreak is believed to have started with so-called “patient zero,” a 2-year-old boy named Emile Ouamouno. The toddler — who was from Guéckédou, a district close to where the three countries meet — died on Dec. 6, 2013, only four days after first exhibiting hemorrhagic fever, black stool, vomiting and other hallmark symptoms of the disease, which first appeared in 1976.

In the last year, Ebola has spread like wildfire across three countries whose health systems were among the least equipped to handle it. According to the World Health Organization, the Ebola virus has infected more than 16,000 West Africans, killed nearly 7,000 and spread panic across the globe. Nigeria saw eight Ebola deaths before eradicating the disease. New cases recently appeared in Mali, which had contained an earlier outbreak. Isolated cases have also emerged in Senegal, Spain and the United States, though on a much smaller scale.

Even so, the death of Liberian citizen Thomas Eric Duncan at a Dallas hospital — and the subsequent Ebola infections of two nurses who had treated him — spread fear across the nation, while controversy over the Obama administration’s handing of Ebola and talk of a travel ban from West Africa became a hot potato in the Nov. 4 midterms.

Over a four-day span leading up to the elections, candidates for both the House and Senate ran 734 ads about Ebola, according to Kantar Media. In a recent poll, nearly two-thirds of Americans worried about a possible widespread Ebola epidemic, despite constant reassurance from experts that the disease would have a hard time spreading in developed countries with advanced health-care systems. In addition to Duncan, a Maryland doctor who had been working in Sierra Leone was transported to the United States last month while critically ill and also died here. Otherwise, there have been eight Ebola patients treated in the U.S., all of whom survived. To put those numbers into perspective, about 90 Americans are killed by guns — each day. Mother Jones magazine called the misplaced panic over Ebola and the Islamic State “the two horsemen of the present American apocalypse.”

The American cases have, however, demonstrated that early, aggressive care seems to boost otherwise dismal survival rates. Human trials for potential vaccines are also underway, and even as Ebola continues to spread rapidly in Sierra Leone and Guinea, transmission of the virus appears to have slowed in hard-hit Liberia, thanks to massive public-awareness campaigns urging citizens to, among other things, quarantine infected family members and not touch the bodies of loved ones who have died of Ebola. (Doctors worry, though, that any tentative gains might inspire complacency in the international community, which has only just begun a forceful response to the outbreak.)

“Most of the highly infected communities are in slums,” said Jeremiah Congbeh Sulunteh, Liberia’s ambassador to the United States. “People who have good housing and good water systems are not likely to get infected. But it’s very difficult to stop kids from playing together. Liberians have also been told not to shake hands. Whether we’ll go back to that later on, I don’t know.”

Last month, The Washington Diplomat met at the Liberian Embassy with the ambassadors of the three African countries at the epicenter of the Ebola epidemic: Sierra Leone’s Stevens, Liberia’s Sulunteh and Guinea’s Mamady Condé.

“Some of our colleagues have been calling us the Ebola ambassadors,” Sulunteh said, a slight touch of sarcasm in his voice.

Photo: Chief Petty Officer Jerrold Diederich / U.S. Army Africa

U.S. Navy Lt. Jose Garcia inspects specimen labels and prepares for the first step in sample-processing at a Naval Medical Research Center (NMRC) mobile laboratory located on Bushrod Island in Liberia. The NMRC sent two mobile testing labs to Liberia to support Operation United Assistance; each two-person lab is capable of testing up to 80 samples per day.

“We have been working as a team, meeting periodically to compare notes and see what lessons we can learn from each other,” he said. “We’ve taken trips to New York together, and we were recently in Atlanta, meeting with Dr. [Thomas] Frieden and other authorities at the CDC [Centers for Disease Control and Prevention].”

Added Stevens: “I often tell people we are the face of Ebola in Washington. Every time there are meetings at universities or NGOs, they call the three of us to talk about Ebola. People want firsthand information about what’s happening. We share information and talk almost on a daily basis.”

Liberia, founded in 1820 by freed American slaves, has borne the brunt of the current epidemic. As of Nov. 12, it has reported over 6,800 cases of Ebola and more than 2,800 deaths (over half the Ebola deaths worldwide). Making matters worse, the Tennessee-size tropical country only recently emerged from back-to-back civil wars that killed an estimated 250,000 people and displaced 1.5 million.

“It’s a difficult time for West Africa and for Liberia, especially for a country coming out of a war which affected the fabric of our country and all of its institutions and infrastructure. It caused brain drain. Professionals left the country — doctors, nurses, teachers, professors,” said Sulunteh.

“But since 2003, we’ve had relative peace. The warring factions signed a peace accord, paving the way for an interim government that was backed by the international community and the United Nations, which provided about 15,000 peacekeepers.”

Sulunteh, 55, comes from the village of Suakoko, which is located in Bong County, Liberia’s third most populous. His parents were subsistence farmers.

“I wasn’t born in a hospital, because there were no hospitals in my community. There were no schools, either. I had to walk three miles to school every morning, and three miles back, until I was 8 years old.”

Sulunteh waited out Liberia’s civil war as a refugee in Côte d’Ivoire, then won a scholarship to study at the American University in Cairo. He immigrated to Canada and returned to Liberia after the war ended. A one-time candidate for vice president, he served as minister of transport, communications and then minister of labor before arriving in Washington two years ago as ambassador. He was also an economics professor at the University of Liberia and Cuttington University, also in Liberia.

“We have a lot of natural resources — iron ore, diamonds and rubber. Firestone has 1 million acres of land planted with rubber, making us the second-largest producer of rubber in the world,” Sulunteh said, noting that Liberia has attracted $17 billion in foreign direct investment since the end of the war.

“However, this $17 billion can only be converted into job-creating opportunities when you have infrastructure. We have a broken health-care system, the roads are dilapidated and electricity has collapsed.”

And that was before Ebola. Now, Sulunteh lamented, “all the gains that were being made have been reversed. Since Aug. 1, civil servants are not working. Factories are closed down, foreign investments are on hold and everything has been affected.”

Liberia’s embassy itself has been hurt as well. Usually, the mission earns $30,000 to $50,000 a month in visa fees charged to U.S. tourists and visitors on business trips.

“But because of Ebola, no one is going to Liberia, so revenues from visas have been zero since July,” Sulunteh told us. “I’m sorry I have to say it, but I’m very worried how we’ll pay our bills by the end of this month. If we don’t have visa fees, we cannot cover our operational costs. We all hope conditions will improve sometime soon.”

Photo: Army Africa (USARAF) / Cmdr. Peter Niles

Three decontamination workers assigned to treat Ebola patients in Liberia come out of the "hot zone" behind the orange lattice fencing. They only work 45 minutes to one hour in the hot zone at a time.

The ambassador said he applauds the U.S. government’s efforts to help Liberia fight the Ebola plague. The Pentagon will deploy some 3,000 soldiers to West Africa to build 17 Ebola treatment units (ETUs). The first ETU opened Nov. 10 in Tubmanburg, about 60 kilometers north of Monrovia, the capital, where the U.S. has also constructed a 25-bed field hospital dedicated to treating infected health workers.

“This is the largest-ever U.S. response to a global health crisis,” said Bill Berger, disaster response team leader at USAID.

In early November, Obama asked Congress for $6.18 billion in emergency spending to fight Ebola both in the United States and in West Africa. The funding request was quickly met with skepticism by Republicans who’ve been critical of the administration’s efforts to fight the disease, here and abroad. The money would go toward building new clinics, distributing food and supplies, and training health care workers and burial teams in West Africa, in addition to training U.S. hospitals.

“My foremost priority is to protect the health and safety of Americans, and this request supports all necessary steps to fortify our domestic health system and prevent any outbreaks at home,” the president wrote in a Nov. 4 letter to House Speaker John Boehner (R-Ohio). “Over the longer term, my administration recognizes that the best way to prevent additional cases at home will be to contain and eliminate the epidemic at its source in Africa.”

Sulunteh said that even though the infection rate is subsiding in Monrovia, Liberia still needs more training of local doctors and nurses, and more ambulances (only about a dozen were available for 4 million people, in good times).

“President Obama was kind enough, on behalf of the American people, to commit troops to help with building the needed infrastructure. They’re also sending supplies, but we need more of that. I appreciate the support that’s been coming in the last month or two, but had that been the case three or four months ago, we would have been able to contain this virus,” he complained.

“Part of the reason Ebola has spread so fast is the lack of ambulances. If a relative is sick or suspected of having Ebola and there’s no ambulance, they’ll revert to public transport. They’ll take a sick person by taxi to the nearest hospital. The driver may not be aware, and all the people who ride in that taxi will get infected.”

Sulunteh, who’s in touch with President Sirleaf on a weekly basis, said Ebola now takes up 95 percent of his time as ambassador — meeting with experts, making speeches, doing media interviews and sorting out bureaucratic issues.

But he’s also heard plenty of grumbling from Liberian immigrants suddenly being viewed with suspicion. One employee of a local nursing home told him she was ordered by a supervisor to get checked for Ebola simply because she’s African. Even people who’ve traveled to places like Kenya and South Africa, thousands of miles from the epidemic, are sometimes being asked to stay away from schools and other public places.

“We are getting an enormous amount of pressure from Liberians in the diaspora community who feel they’re not being treated well,” the ambassador said. “Most [Americans] are in sympathy with us. But some may not want to interact with you, simply because you come from Liberia.

Photo: U.S. DoD, Army Sgt. 1st Class Tyrone C. Marshall, Jr.

Naval Medical Research Bio Defense Chief of Clinical Re- search James Lawler, right, leads a group of students in re- moving their personal protective equipment during a training session at the San Antonio Military Medical Center in Texas. The students are part of a 30-person team designated to "prepare to deploy" in the event of an Ebola crisis in the U.S.

“Last week, my security guard saw a fellow coming into the embassy. He used his shirt to open the door handle. That’s just ludicrous,” Sulunteh said. “People assume if you’re black and you come from Africa, you have Ebola. We don’t think embassy people should be treated that way. Do our embassy staffers now have to start wearing gloves?”

Stevens has similar frustrations.

“The Duncan case in Texas — after he died and then the nurses working with him got infected — that was the main genesis of this phobia that has engulfed the American population,” he said.

Meanwhile, the pattern and rate of Ebola transmission have been quietly shifting. In the most recent three-week monitoring period, Sierra Leone reported three times as many new Ebola infections as Liberia, according to the World Health Organization (infections have also waned somewhat in Guinea).

“There’s hardly anything we do now that doesn’t concern Ebola,” said Stevens, adding that the epidemic has consumed virtually all his waking hours. “This is time I would normally spend on seeing congressmen and senators to get support for my country for the Millennium Challenge Corp., and now that has to be reduced because of my engagement with fighting Ebola.”

Stevens, 63, is the son of Sierra Leone’s first president, Siaka Stevens, who led the country from 1971 to 1985. Koroma named him ambassador to Washington in 2007; previously, he was posted to London and Conakry, Guinea’s capital.

Like its neighbor Liberia, Sierra Leone was wracked by years of civil war. The conflict, lasting from 1991 to 2002, left some 70,000 people dead, 2.5 million displaced and the economy in ruins. Despite ample natural resources including diamonds, gold, bauxite, iron ore, fish, coffee and cocoa, Sierra Leone ranks 183rd out of 188 countries on the U.N. Development Program’s latest Human Development Index.

When Nigeria’s first case of Ebola was announced in late July, the news terrified health experts around the world. After all, an outbreak in densely packed Lagos would have been catastrophic for Africa. Yet unlike oil-rich Nigeria, which Stevens said had the money and resources to fight the epidemic — and which was declared Ebola-free in October — Sierra Leone simply wasn’t prepared.

“Ebola took us by storm, and within the space of three weeks, it overwhelmed our medical services, and they collapsed,” said the ambassador, urging Congress and the White House to do more. “The best thing is boots on the ground. The Americans must fight Ebola at the source, and not wait until we get outbreaks in the United States. It would cost much more to treat Ebola in the U.S. than in Africa.”

Photo: CDC / World Health Organization (WHO)

This World Health Organization map illustrates the geographic distribution, as of Oct. 10, of the West African Ebola outbreak and demarcates some of the focal points involved in the epidemiologic investigation of what has become an international epidemic, including the location of Ebola Treatment Units (ETUs), field laboratories, transit centers and hospitals.

Stevens said he’s often awakened in the middle of the night with urgent requests. For example, one recent late-night call came from a group of 25 medical volunteers from Massachusetts who needed visas issued immediately.

“Our embassy is actively engaged,” he said. “The United States has the largest numbers of Sierra Leoneans [abroad]. Many of them are qualified nurses, doctors, epidemiologists and paramedics. The first thing we did was to call our community together and let them appreciate the magnitude of the problems we have. We opened a bank account, and Sierra Leoneans have started contributing.”

A new Ebola response call center in Freetown, reached by calling 117, has helped local residents notify the authorities when an infected person dies, or when someone becomes infected. Sierra Leone currently has four ETUs built by the British, the country’s former colonial masters; a fifth, capable of caring for 200 patients, is nearing completion.

“The turnaround time is very important, from the time a case is identified and the blood samples are taken and confirmed whether it’s Ebola or not,” Stevens said. “Right now it’s about four to five days. The Chinese and the Cubans have told us they can do it within 24 hours.”

But in a sign of the hurdles that cash-strapped governments face, hundreds of staff at a clinic in southern Sierra Leone run by Doctors Without Borders recently went on strike to protest the government’s failure to pay them promised “hazard payments,” leaving some Ebola patients stranded.

Widespread mistrust and misinformation have also contributed to the problem: Conspiracies that the West manufactured and spread Ebola emerged early in the crisis, and fear kept many people from sending sick family members to the hospital — and even led to attacks against health-care workers. Some have also stubbornly clung to traditional customs that have exacerbated the disease, which is spread via contact with the bodily fluids of infected people.

Yet throughout West Africa, the Ebola epidemic is abruptly changing social customs such as shaking hands, hugging and affectionately kissing the bodies of the newly departed. “One of the problems we’re having is burying the dead. That was the main area of infection,” Stevens said, noting that “nobody in Sierra Leone shakes hands anymore.”

But one precaution he thinks goes too far: The ambassador harshly criticized mandatory quarantines being imposed by states such as New York and New Jersey on health workers coming back from West Africa.

“I think President Obama has stuck his neck out. It’s not by being scared of what has happened that we can solve the problem. We have to solve the problem at its source, in West Africa, and stop stigmatizing those who are leaving America to work there and then come back. It’s not good for those who might want to volunteer,” he said.

“Quarantines affect even our own people,” Stevens complained. “They dampen the spirit of those who might want to go, when they hear they’ll be kept for 21 days and that when they come back, they might lose their jobs.”

British Airways and Air France stopped serving Sierra Leone as soon as the Ebola outbreak began. Now only Brussels Airlines and Royal Air Maroc fly to Freetown. “We are glad at least we have those two serving us,” said Stevens.

“The economic consequences of this scourge have already started affecting us,” he added. “Revenue has dropped by a third, and most of the big industries that were actually employing people are closing, so it will have a huge impact on the economy. That’s why we need a lot of understanding and collaboration from financial institutions.”

Stevens predicted that Sierra Leone will “have Ebola under some control” by the end of December, though outright eradication will take much longer.

Sulunteh said Liberia will need at least $300 million in foreign aid to jumpstart its ravaged economy. For now, Sulunteh has cancelled all fundraising events and isn’t even sure if his embassy will host its traditional annual outdoor barbecue and music festival next July to celebrate the 1847 signing of Liberia’s declaration of independence.

“As long as Ebola is raging in Liberia, we are very cautious about gatherings, even though we feel the Ebola situation will be over before then,” Sulunteh said with a dose of skepticism. “After some time, we’ll go back to our regular diplomatic routine, pushing foreign policy and discussing bilateral issues.”

But the ambassador warned: “This isn’t like a conventional war. Ebola does not talk, and it does not know borders. The more we wait, the more it gets out of hand.”